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3 <br /> 'I IONITORING WELL INSTALLATION REP&k <br /> Date: I�' Z�' Z�j CONSTRUCTTON <br /> Premise Address: 3+1 1,614 S r ( 1 Pal Total Depth /16 <br /> Screen Length (from) 1� (to) :�Q <br /> Well No.: k Filter Pack (from) 1:� (to) 40-*, <br /> Bentonite (from) 2 0 (to) 41•'g <br /> Inspector: _ C: Grout (from) (to) I-o ' I�cP <br /> Drilling rig type _ <br /> Permit No. Auger O.D. it, I.D. <br /> Completion - Sto a pipe/cluistie box (circle one) <br /> Drilling Company:. <br /> Driller: � ,�,r-�n� casing <br /> height <br /> Consultant *gr'Geologist L r ABOVE-GROUND COMPLETION SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line <br /> Domestic well on site - (y/(� _,.ft. <br /> If yes, 1 cation and distance - <br /> . .ft. <br /> 2rb 06 b K/ YVI{�11IV <br /> SAMPLING atorei = <br /> EC secicn <br /> Holding Temperature 1 " <br /> Method VZvOI Pack <br /> Screening Method — <br /> Tracking Sheet - n ) — <br /> �ft. ,{4 <br /> SPOILS <br /> Storage Method - �t�3i 1(J MATERIALS/DEVELOPMENT <br /> Contamination Noted - /n ) 1t y <br /> Storage Location D 1J-fj17; Casing type <br /> Blank Wq,<' ft. Screen ft. <br /> Slot size b.0 I D <br /> GROUTING Bags cement (o <br /> Buckets bentonite Z <br /> Depth to water 'L�l • Bags sand/gr.avel _ <br /> Mix Ratios WkA, Filter Pack type/size 17_ <br /> Installation Method - �1 Surge Block: - (19/ n )—T <br /> Quantity Installed Discussed with geologist: - ( n ) <br /> -Type of method ' _ v � <br /> EH 29 29 <br />